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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 04/28/2022
Date Signed: 04/28/2022 04:55:09 PM

Document Has Been Signed on 04/28/2022 04:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:CASA DEL SOL RTF IIFACILITY NUMBER:
374604100
ADMINISTRATOR:VASQUEZ, MANUELFACILITY TYPE:
735
ADDRESS:1141 JULIETTE PLTELEPHONE:
(760) 645-3195
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 4CENSUS: 3DATE:
04/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Manuel Vazquez, Licensee/AdministratorTIME COMPLETED:
05:05 PM
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On 4/28/22 Licensing Program Analyst (LPA) Javina George made an unannounced visit at the facility for the purpose of conducting a health and safety check. LPA George met with Licensee/Administrator Manuel Vazquez, and explained the purpose of the visit. At the time of the visit there was (1) staff and (2) clients present. 1 client remains in the hospital.

LPA observed the facility to be clean and clutter free. LPA observed the facility to have the required amount of food, 2 day supply of perishable and a 7 day supply of non-perishable food items. Dinner was already prepped, and being served.

LPA George reviewed this weeks facility's staff schedule. The facility was within the required ratio of (3:1) at the time of LPAs visit.

LPA greeted and observed both (2) clients, 1 was inside of their bedroom, and the other client was sitting outside in the backyard.

No physical signs of distress or concern were observed, no health and safety concerns were observed at the time of the visit.

An exit interview was conducted, and a copy of this report was provided to Licensee/Administrator Manuel Vasquez.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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